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Madarosis is a terminology that refers to loss of eyebrows or eyelashes. This clinical sign occurs in various diseases ranging from local dermatological disorders to complex systemic diseases. Madarosis can be scarring or non-scarring depending upon the etiology. Appropriate diagnosis is essential for management. Follicular unit transplantation has been found to be a useful method of treating scarring madarosis and the procedure relevant to eyebrow and eyelash reconstruction has been discussed. A useful clinical approach to madarosis has also been included for bedside diagnosis. The literature search was conducted with Pubmed, Medline, and Google scholar using the keywords madarosis, eyebrow loss, and eyelash loss for articles from 1960 to September 2011. Relevant material was also searched in textbooks and used wherever appropriate.

Objective: Our goal was to delineate the epidemiologic and clinical patterns of ocular leprosy in an outpatient setting in the United States. Design: Examinations were performed in 61 consecutive outpatients seen in a Midwestern leprosy clinic. Patients: Forty-three male and 18 female patients were examined. The patients' origins included Southeast Asia (24 patients [39%]), Latin America (23 patients [38%]), India (nine patients [15%]), Europe or North America (two patients [3%]), Africa (two patients [3%]), and the Middle East (one patient [2%]). Results: Thirty-nine percent of patients were classified as having polar lepromatous leprosy; 18%, borderline lepromatous leprosy; 3%, borderline borderline leprosy; 36%, borderline tuberculoid leprosy; 2%, polar tuberculoid leprosy; and 2%, indeterminate leprosy. Ninety-six percent of patients had a best-corrected visual acuity of 20/40 or better. Ocular findings included madarosis (28 patients [46%]), subconjunctival fibrosis (18 patients [30%]), punctate epithelial keratopathy (17 patients [28%]), posterior subcapsular cataract (10 patients [16%]), corneal hypesthesia (10 patients [16%]), lagophthalmos (seven patients [11%]), corneal pannus (six patients [10%]), entropion (five patients [8%]), prominent or beaded corneal nerves (four patients [7%]), iridocyclitis (four patients [7%]), focal avascular keratitis (three patients [5%]), scleritis (three patients [5%]), interstitial keratitis (two patients [3%]), iris pearls (two patients [3%]), and ocular clofazimine crystals (two patients [3%]). Madarosis, corneal hypesthesia, and posterior subscapsular cataracts were significantly associated with disease duration ( P Conclusion: We report herein a relatively low frequency of visual impairment attributable to leprosy in our series compared with that seen among institutionalized leprous patients. However, since 48% of subjects had one or more sight-threatening complications as a result of their disease, a program of regular ophthalmic follow-up is strongly advocated for all patients with leprosy.

Objectives: Breast cancer patients suffer from madarosis (loss of eyelashes) due to chemotherapy side effects. An effective treatment or prevention for alopecia or madarosis induced by chemotherapy is not available. Potential drug side effects of bimatoprost solution include increased eyelash length, darkness, and number. A formulation of bimatoprost which maximizes eyelash enhancement and minimizes intraocular and systemic side effects has not been reported. Materials and Methods: An Institutional Review Board (IRB) and Investigational New Drug (IND) approved, randomized, single-blinded, prospective, internally controlled trial compared bimatoprost eyelash gel in relation to eyelash enhancement of madarosis patients. Forty eyelids of 20 chemotherapy-treated breast cancer patients were randomized to treatment or control (fellow eyelid). Both patient and surgeon (blindly) evaluated bimatoprost gel's effectiveness in improving eyelash appearance at baseline and at monthly intervals. Results: The median follow-up time was 3 months (range 1-4). There was a significant difference between treated and fellow eyelash length during month 2 [1.00 mm (P=0.004)] and month 3 [1.00 mm, P=0.02)], in eyelash pigment [month 1 (2.5, P=0.04); month 2 (2, P=0.0009); month 3 (3, P=0.06)] and thickness [month 2 (2, P=0.002); month 3 (3, P=0.01)]. There was an improvement in the patient satisfaction scale from baseline 16 (median, range 7-21) to 26 (median, range 17-33, P=0.002) at last follow-up. Conclusions: Bimatoprost eyelash gel appears promising for chemotherapy-induced madarosis. Patients may find the effects restorative and cosmetically enhancing.

Purpose: To evaluate the results of reconstruction of large defects in the upper lid using two composite contra-lateral eyelid margin grafts. Methods: This is an interventional case series in which a large full thickness defect of the upper lid was reconstructed in 7 patients using two composite eyelid margin grafts and myocutaneous advancement. The grafts were taken from both eyelids of the contra lateral eye and the final outcome was evaluated. Results: Cosmetic results were achieved in both donor and recipient eyes satisfying to all patients; no graft sloughing was seen. Transient edema, punctate epithelial erosions, lid notching, madarosis and ptosis were seen in the early postoperative period. Conclusion: Reconstruction of a large defect in the upper lid with two composite eyelid-margin grafts is an easy, safe, effective technique with minimal complications.

Six eyelashes, three from the upper lid and three from the lower lid, were epilated from 256 subjects and examined for Demodex. D. folliculorum (Simon) was found in 16% of the subjects. Mites were more abundant in older persons and in persons with diabetes. Mites also were associated with a scarcity of lashes in the lower lid. Hierarchical log-linear analysis showed that the associations of greater mite abundance with diabetes and with madarosis were independent of age. The 43 persons from whose lid margins Staphylococcus aureus was cultured seemed to have been more likely to have two or more mites than those without S. aureus (11.6 versus 5.2%), although this difference fell short of statistical significance ( P = 0.125).

Background: Virus-associated trichodysplasia spinulosa (VATD) is a relatively new entity associated with a distinctive histologic picture of distended follicles with excessive production of inner root sheath material. Only two patients have thus far been reported. Both had developed the condition after a kidney transplant. Observation: We report two additional cases of VATD. One is a nineteen year-old man with a history of acute lymphocytic leukemia, who developed a papular facial eruption as well as madarosis. The other is a nine year-old boy, who presented with facial papules after a kidney transplant. Histologic examination of both cases reveals characteristic findings for trichodysplasia spinulosa, but also indicates a spectrum of histologic alterations. Ultrastructural studies confirm the presence of a variable number of intranuclear viral particles. Conclusions: Our cases illustrate the histologic spectrum seen in association with VATD. The severity of histologic alterations corresponds to the viral load seen by electron microscopy. This report documents for the first time that VATD can be found in patients without a solid organ transplant. Increased awareness of the distinct histologic picture associated with VATD will likely lead to more frequent diagnosis of this under-recognized entity.

Out of 742 out-patients screened for ocular disease, 177 (24%) had eye lesions due to leprosy. These were more in the lepromatous spectrum of the disease and showed increasing trend with age of patient and duration of the disease. Madarosis was the commonest lesion (76%). The serious and sight threatening lesions like lagophthalmos, corneal anaesthesia, corneal opacities and ulcers, iritis and complicated cataracts constituted 8.22% of the lesions. Blindness due to corneal opacity and complicated cataract developed in 6 patients, constituting 3.4% of eye lesions with a prevalence rate of 0.8% among all the leprosy patients. Although the blinding lesions occurred in a very small percentage of patients, most of these are preventable through early recognition and institution of appropriate treatment. The simple techniques of examination to detect potentially sight threatening lesions should be taught to all leprosy workers to prevent blindness among leprosy patients.

A patient treated with short-term, topically applied epinephrine hydrochloride therapy to one eye developed madarosis in that eye. After the therapy was discontinued, the lashes regrew.

Loss of eyebrow hair (madarosis) is one of those signs which delights the elegant practitioner of the art of physical diagnosis, for at a glance he can recognize a number of otherwise unrelated diseases. Hypertrichosis of the eyebrows is also a sign which demands explanation when not on the basis of heredity. On this page are a collection of illustrative examples in which changes in the normal pattern of eyebrow growth give a major clue to the underlying problem.